Repairs Inquiry Form

Do you live in SW of Lancaster City, Elizabethtown, East Petersburg, Lebanon or Lititz?yesno

Are you a homeowner?yesno

Are you a US Citizen or a legal permanent resident?yesno

Are you and the members of your household willing to work volunteers hours on the repair project?yesno

Contact Information

Applicant Name(s) (required)

Address (required)

City (required)

State (required)

Zip Code (required)

Home Phone

Email

How many people will be living with you if you are accepted in the program? (Circle one, and include yourself and any co-applicant in the total. For example, an applicant and co-applicant with two children would select 4.)

If you are a homeowner and are interested in the home repair program please describe your home repair needs:

Please share how you learned about Lancaster Lebanon Habitat for Humanity: